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Volume 25, Number 10—October 2019

Self-Flagellation as Possible Route of Human T-Cell Lymphotropic Virus Type 1 Transmission

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To the Editor: Blood donors in Australia who test positive for transfusion-transmissible infections, including human T-lymphotropic virus (HTLV), hepatitis B virus (HBV), hepatitis C virus, and HIV, undergo posttest counseling, as previously described (1). Similar to Tang et al. (2), we identified self-flagellation as a possible unique risk factor for HTLV-1 infection. History of self-flagellation was elicited in 7 (28%) of 25 HTLV-1–positive donors identified during January 2012–December 2018. All 7 donors were men 20–37 years of age, of whom 5 were born in Pakistan and 2 in India; 6 had given blood in Victoria, Australia. The 18 remaining HTLV-1–positive donors were 29–68 years of age; 10 (56%) were men; 1 was born in India and none in Pakistan; and 7 (39%) gave blood in Victoria.

HBV shares transmission routes with HTLV-1 and is highly infectious, including through minor blood exposures (3). After discussion of recognized infective risk factors, the 610 HBV-positive donors from the same period, of whom 83 were born in India or Pakistan, were asked about any other potential blood exposures. None reported self-flagellation.

At the time of posttest counseling, no previous HTLV results were available for donors reporting self-flagellation or for their family members. Until the known modes of vertical and sexual transmission have been excluded by such results, the likelihood of self-flagellation as an infective risk factor remains unclear. Although India and Pakistan are not known to be geographic risk areas for HTLV-1, few prevalence studies are available (4), and HTLV-1 is commonly present in small geographic foci (5). In addition, a noticeable degree of transmission through communal self-flagellation would first require a raised prevalence of infection among the practicing group. We look forward to further research that may clarify the apparent link between self-flagellation and HTLV-1 infection.



Australian governments fund the Australian Red Cross Blood Service for the provision of blood, blood products, and services to the Australian community.


Claire E. StylesComments to Author , Veronica C. Hoad, Paula Denham-Ricks, Dianne Brown, and Clive R. Seed
Author affiliations: Australian Red Cross Blood Service, Perth, Western Australia, Australia (C.E. Styles, V.C. Hoad, C.R. Seed); Australian Red Cross Blood Service, Melbourne, Victoria, Australia (P. Denham-Ricks, D. Brown)



  1. Polizzotto  MN, Wood  EM, Ingham  H, Keller  AJ; Australian Red Cross Blood Service Donor and Product Safety Team. Reducing the risk of transfusion-transmissible viral infection through blood donor selection: the Australian experience 2000 through 2006. Transfusion. 2008;48:5563.PubMedGoogle Scholar
  2. Tang  AR, Taylor  GP, Dhasmana  D. Self-flagellation as possible route of human T-cell lymphotropic virus type-1 transmission. Emerg Infect Dis. 2019;25:8113. DOIPubMedGoogle Scholar
  3. Trépo  C, Chan  HL, Lok  A. Hepatitis B virus infection. Lancet. 2014;384:205363. DOIPubMedGoogle Scholar
  4. Niazi  SK, Bhatti  FA, Salamat  N. Seroprevalence of human T-cell lymphotropic virus-1/2 in blood donors in northern Pakistan: implications for blood donor screening. J Coll Physicians Surg Pak. 2015;25:8747.PubMedGoogle Scholar
  5. Gessain  A, Cassar  O. Epidemiological aspects and world distribution of HTLV-1 infection. Front Microbiol. 2012;3:388. DOIPubMedGoogle Scholar


Cite This Article

DOI: 10.3201/eid2510.190484

Original Publication Date: September 04, 2019

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Claire E. Styles, Australian Red Cross Blood Service, GPO Box B80, Perth, Western Australia 6838, Australia

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Page created: September 17, 2019
Page updated: September 17, 2019
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The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.